Provider Demographics
NPI:1205379567
Name:BURNISON, LEAH D (LCAC)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:D
Last Name:BURNISON
Suffix:
Gender:F
Credentials:LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 S CLAIRBORNE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-1857
Mailing Address - Country:US
Mailing Address - Phone:913-730-3664
Mailing Address - Fax:
Practice Address - Street 1:407 S CLAIRBORNE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1857
Practice Address - Country:US
Practice Address - Phone:913-730-3664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-18
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST-LMAC 211101YA0400X
KSLCAC 606101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)